Provider Demographics
NPI:1356301527
Name:OFICINA MEDICA DEL DR. J.A. BURGOS, C.S.P.
Entity Type:Organization
Organization Name:OFICINA MEDICA DEL DR. J.A. BURGOS, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-714-0144
Mailing Address - Street 1:PO BOX 9737
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9737
Mailing Address - Country:US
Mailing Address - Phone:787-714-0144
Mailing Address - Fax:787-714-0230
Practice Address - Street 1:CENTRO DE SALUD FAMILIAR MENONITA CARR. 172 AVE. EL
Practice Address - Street 2:JIBARO KM.3.3 OFICINA 107
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-714-0144
Practice Address - Fax:787-714-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9632208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGO4556Medicare UPIN
PR0081682Medicare ID - Type Unspecified